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Biomedical subjects

A M Alexander

Publications and source records attributed to A M Alexander.

At least 19 recordsLinked to original sources

Pyrosequence-based typing of alleles of the HLA-DQB1 gene.

DNA typing of alleles of the highly polymorphic HLA-DQBI gene was performed by Pyrosequencing using purified DNA from the 11th International Histocompatibility Workshop human cell lines and samples from the Children's Hospital of Pittsburgh registry of diabetics and their first-degree relatives. Pyrosequencing was optimized for genotyping exon 2 of the HLA-DQB1 gene, but the procedure should be applicable to other HLA loci. The 47 HLA-DQB1 alleles were readily identifiable, as were the 1,128 potential allelic heterozygous combinations. The method required PCR conditions that specifically amplified DQB1 but not the pseudogene, DQB2. The new method of pyrosequence-based typing can be performed in 96- or 384-well format. The 61 polymorphic residues of DQB1 exon 2 were identified within four pyrosequencing reactions, obtained by a 70-nucleotide read length in each reaction, in about an hour's time. Allelic combinations of HLA-DQB1 most frequentlyfound in the population of diabetics and their immediate family members were analyzed and successfully compared to typing of the DQB1 alleles by sequence-specific oligonucleotide probe protocols. Pyrosequence-based typing is compatible with genotyping of allelic combinations expected from heterozygous individuals, resulting in nucleotide resolution of the highly polymorphic HLA system. Using pyrosequencing, more than 750 sample wells can be processed in a working day, resulting in the identification of more than 50,000 bases.

Alleles↗

Restricted TCR V beta gene expression and enterovirus infection in type I diabetes: a pilot study.

AIMS/HYPOTHESIS: High frequencies of T-cell receptor (TCR) V beta 7+ T cells were detected among the lymphocytes isolated from pancreatic islets of children at the onset of Type I (insulin-dependent) diabetes mellitus. We assessed whether a preferential expression of certain TCR V beta gene families could also be detected among the peripheral blood mononuclear cells from diabetic patients. METHODS: T-cell receptor repertoires were evaluated by using a semi-quantitative RT-PCR-based technique and confirmed by FACS analysis in peripheral blood mononuclear cells from diabetic patients before, at and after onset of the disease. These patients were also tested for exposure to enteroviruses by RT-PCR and by measuring titres of enterovirus-specific antibodies of the IgA, IgG, and IgM classes. RESULTS: T-cell receptor V beta 7 gene family values were higher in recently-diagnosed diabetic patients (10.5% +/- 3.7) than in age-matched non-diabetic control subjects (5.1% +/- 1.6) (p < 0.001). In a time-course analysis of people who developed diabetes during clinical monitoring (i.e., converters), T-cell receptor V beta 7 gene expression showed values consistently above 10% (p < 0.0005). Long-standing diabetic patients showed lower percentage of V beta 7 expression compared to values measured at disease onset. In the longitudinal study of the converters, multiple acute enterovirus infections were also detected. These infections appeared to be temporally related to increased percentage of V beta 7 gene transcripts. CONCLUSION/INTERPRETATION: The deviation in the T-cell receptor V beta repertoire among circulating T cells from diabetic patients seems to re-emphasize the importance of enterovirus infections in accelerating the progression of Type I diabetes.

Adolescent↗

Anti-rheumatic and analgesic drug usage and acute gastro-intestinal bleeding in elderly patients.

The records of 1878 general medical in-patients (aged 75 years and over) at Hereford have been examined for associations between the commonly used antirheumatic and analgesic drugs and acute gastro-intestinal bleeding. One third of 93 in-patients admitted because of acute bleeding had been taking ibuprofen, indomethacin or aspirin. The usage of these drugs was significantly greater than in the control population who comprised the remaining 1785 elderly medical in-patients. It is suggested that very elderly patients taking any of these three drugs form a vulnerable high risk group who are liable to develop acute gastro-intestinal bleeding.

Acute Disease↗

The Hereford Hospital Prescribing Study. The function of a clinical pharmacist on the medical wards of a district general hospital.

The role of a clinical pharmacist is outlined as interviewing patients on admission, monitoring of 'at risk' patients and drugs, and counselling on discharge. These functions were assessed on a 118 bed medical unit to try to quantify the potential workload and staff requirements needed to achieve it. It is suggested that the establishment of pharmacists for ward pharmacy services may need to be increased two-fold to accomplish the outlined role, and that a 24-hour service would be needed to cover some duties. However, before such a level of staffing can be achieved, the positive benefits of clinical pharmacy must be demonstrated.

England↗

The Hereford Hospitals prescribing study. Changes in the prescribing patterns of anti-bacterial agents in the medical wards of a district general hospital over four years.

Analysis of the prescribing of systemic anti-bacterial drugs in the medical wards of a district general hospital from April 1975 to March 1979 showed that 26% of patients received these drugs and that ampicillin, amoxycillin and cotrimoxazole were prescribed much more frequently than other agents. During this time, there were considerable changes in prescribing habits, with increases noted in amoxycillin, flucloxacillin and metronidazole. These changes were paralleled by decreases in ampicillin, cloxacillin and clindamycin usage.

Anti-Infective Agents↗

The Hereford Hospital Prescribing Study. Investigation of methods to identify patients with adverse drug reactions.

Four investigatory procedures are described for the detection of patients with possible adverse drug reactions. These were evaluated using computer data from the Hereford Hospital Prescribing Study. 120 patients receiving Indomethacin were studied from the total data base of 2,852 admissions during 1977. From this study, two of the methods involving the identification of the discontinuation of drug therapies and the prescribing of 'antidotes' seemed to be the most useful. These methods were also applicable to the routine monitoring of prescription sheets by ward pharmacists.

Adolescent↗

Interaction of aminoglycoside antibiotics with phospholipid liposomes studies by microelectrophoresis.

Microelectrophoresis was found to be a rapid method for studying the interaction between aminoglycoside antibiotics and liposomes prepared from acid phospholipids. The ability to cause charge reversal of liposomes prepared from phosphatidyl inositol was ranked in the order neomycin greater than gentamicin greater than tobramycin greater than amikacin greater than kanamycin greater than ribostamycin greater than streptomycin greater than dihydrostreptomycin greater than Ca2+. Similar results were obtained with liposomes prepared from a mixture (8: 2) of phosphatidyl choline and phosphatidic acid, but no effect was detectable with neutral liposomes made from phosphatidyl choline only. The results support the view that the attraction between positively charged nitrogen groups on the antibiotics and the negatively charged groups of acidic phospholipids are predominantly responsible for the interaction. Extension of the studies to ionic strengths and calcium concentrations similar to those found in vivo showed a reduction, but not elimination, of the observed effects.

Aminoglycosides↗

Molluscum contagiosum: the volcano phenomenon.

Molluscum contagiosum, a common cutaneous viral infection, responds to a variety of therapeutic modalities, but patient cooperation often limits the practitioner's choice. In an effort to provide minimally traumatic treatment for a four year old boy with this dermatosis, an interesting phenomenon was chanced upon, which greatly facilitated therapy.

Anesthesia, Local↗